Editorial

Since the introduction of the Quality and Outcomes Framework (QOF), GPs have been incentivised to keep a register of patients diagnosed with heart failure (HF). Such registers are only effective if they are audited regularly, since they are likely to contain errors and omissions. GRASP-HF is a new tool designed to help busy practices achieve a systematic approach to the identification, diagnosis and management of patients with HF.

"There are two objects of medical education: to heal the sick and to advance the science."

Through the support of NHS Improvement, Guidance on Risk Assessment for Stroke Prevention in Atrial Fibrillation (GRASP-AF) has been rolled out nationally. Nearly 2,000 practices have adopted the GRASP concept, representing an overall population of 13 million.

Exercise is a preventive tool in combating cardiovascular disease, type 2 diabetes and obesity: an extra 12 minutes a day could make a big difference.

In-house D-dimer testing and the Wells Score combined meant that cases were referred to secondary care only when patients were strongly suspected to have VTE or pulmonary embolism. Some 86% of VTE cases had properly documented risk assessment.

"The hardest conviction to get into the mind of a beginner is that the education upon which he is engaged is not a medical course but a life course, for which the work of a few years under teachers is but a preparation."Sir William Osler (1849-1919), from The Student of Medicine.

The 2012 ESC guidelines on heart failure, published only two years after the updated NICE guideline, spell out therapeutic advances about which doctors need to be aware. They include recommendations on mineralocorticoid receptor antagonists (MRAs), ivabradine and cardiac resynchronisation therapy (CRT).

For most people symptoms can be controlled by optimal medical management and healthy lifestyle choices. Revascularisation gives symptom relief but is not without risk, and its long-term benefits remain uncertain.